肝癌经导管动脉化疗栓塞术后发生栓塞综合征的影响因素

目的 探讨肝癌经导管动脉化疗栓塞术（TACE）后发生栓塞综合征（PES）的影响因素。方法 将148例经TACE治疗的肝癌患者按是否发生PES分为PES组和NPES组,每组74例。对比两组患者的一般资料,分析PES发生的危险因素。结果 NPES组与PES组患者性别、微球种类、微球个数、术前美国东部肿瘤协作组（ECOG）体力状况（PS）评分、巴塞罗那临床肝癌（BCLC）分期比较,差异均有统计学意义（P﹤0.05）。多因素分析显示,女性、术前ECOG PS评分较高、BCLC分期偏高、术中应用载药微球、微球个数较多均为肝癌患者TACE术后发生PES的危险因素（P﹤0.05）。结论 女性、术前ECOG PS评分较高、微球种类为载药微球、微球个数较多、BCLC分期偏高均为肝癌患者TACE术后发生PES的危险因素,应于围手术期对具备上述危险因素的患者给予针对性干预,以提高介入治疗的安全性与患者预后。     

肝动脉化疗栓塞术对肝癌患者乙肝病毒活动状态的影响

目的：观察经导管肝动脉化疗栓塞术（TACE）治疗原发性肝细胞肝癌（HCC）对患者乙肝病毒活动状态及肝功能的影响。方法：动态检测81例乙肝标志物阳性HCC患者TACE术前、术后HBVDNA定量及肝功能变化。结果：81例患者行TACE术后，32例出现HBV激活，激活率为39．5％（32／81）；TACE术前HBVDNA定量为（4．2±0．6）×10^4copies／ml，低于术后（5．8±0．3）×10^5copies／ml（P〈0．05）；激活组32例中75％出现明显肝损害，高于非激活组40．8％（P〈0．05）。结论：TACE治疗将引起HCC患者HBV激活，可能加重肝功能损害，应值得高度重视。     

高强度聚焦超声联合肝动脉化疗栓塞对肝癌血清TSGF及AFP的影响

目的：观察高强度聚焦超声（HIFU）联合肝动脉化疗栓塞（TACE）对原发性肝癌血清TSGF及AFP的影响。方法：原发性肝癌患者60例,男43例,女．17例,年龄29—50岁（平均40．9岁）。入选肝癌直径均〈5cm,其中30例为观察组,选择HIFU联合TACE治疗,其余30例为对照组,仅给予单纯TACE治疗。TACE所用药物为5-氟尿嘧啶1．0g、表阿霉素30mg。分别检测术前、术后4周血清恶性肿瘤生长因子（TSGF）和甲胎蛋白（AFP）水平并进行比较。术后4周根据WHO疗效标准判定疗效。结果：HIFU联合TACE治疗后患者血清TSGF水平下降较对照组明显（P〈0．05）,且较AFP水平下降明显（P〈0．05）;观察组显效（CR＋PR）21例,有效（SD）8例,无效（PD）1例,总有效率96．67％,对照组显效（CR＋PR）13例,有效（SD）12例,无效（PD）5例,总有效率83．33％,两组疗效差异有统计学意义（P〈0．05）。结论：HIFU联合TACE治疗明显降低患者血清TSGF水平;血清TSGF对疗效的敏感性优于AFP。     

大肝癌患者行 TACE 序贯射频消融的疗效及复发因素

目的：探讨经导管肝动脉化疗栓塞（TACE）联合序贯射频消融术（RFA）治疗大肝癌患者的疗效及复发因素。方法：选取我院2013年1月－2015年1月肿瘤外科中晚期原发性大肝癌患者110例并分为肝动脉化疗栓塞组（TACE 组）与肝动脉化疗栓塞联合序贯经皮射频消融术组（TACE ＋RFA 组）各55例,TACE 组患者行一次或多次单一肝动脉化疗治疗;TACE ＋RFA 组在肝动脉化疗治疗结束后1～2周再行序贯经皮射频消融术治疗。结果：TACE 组与 TACE ＋RFA 组总有效率分别为63．64％（35／55）、94．54％（52／55）。TACE ＋RFA 组1年生存率为72．7％（40／55）,2年生存率为20．0％（11／55）,而 TACE 组分别为56．36％（31／55）、7．27％（4／55）。Log －rank 检验结果显示肿瘤数量、分期、血清甲胎蛋白水平等为大肝癌患者预后的因素,与患者预后有一定关系。结论：经导管肝动脉化疗栓塞（TACE）联合经皮射频消融术（RFA）治疗原发性中晚期大肝癌可以有效提高患者生存率,延长患者的生存期。肿瘤数量、直径、分期等是影响患者复发的危险因素。     

肝动脉化疗栓塞联合三维适形放疗治疗原发性肝癌

[目的]探讨肝动脉介入化疗栓塞术（TACE）联合三维适形放疗（3D42RT）治疗原发性肝癌的疗效。[方法]44例原发性肝癌患者用抽签法随机分为A组、B组，A组22例先予TACE治疗2～3次，3周后进行3D-CRT，放射剂量为2～3Gy／次，5次／周，总剂量为50Gy～60Gy；B组22例单纯行TACE治疗2～3次。[结果]A组有效率为86．3％，B组有效率为54．5％，A组有效率明显高于B组（P〈0．05），A组的1、2年生存率分别为72．7％和50．0％，B组的1、2年生存率分别为45．5％和18.3％，A组生存率亦明显高于B组（P〈0．05）。两组间毒副反应无明显差异（P〉0．05）。[结论]TACE联合3D-CRT能提高原发性肝癌的疗效，毒副反应可以耐受。     

肝动脉化疗栓塞联合射频消融治疗中晚期肝癌的临床疗效

目的探讨肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗中晚期肝癌的临床疗效。方法62例具有介入治疗指征的中晚期肝癌患者随机均分为2组,对照组31例单独行TACE治疗,观察组31例行TACE联合RFA治疗。比较观察2组的临床疗效及AFP水平。结果观察组总有效率为87．1％,高于对照组的51．6％（P〈0．05）。观察组术后AFP水平明显低于对照组（P〈0．05）。随访24个月各时期的生存率观察组均明显高于对照组（P〈0．05）。结论TACE联合RFA治疗中晚期肝癌安全、可靠,可提高患者生存率,延长患者生存时间,疗效优于单独应用TACE。     

介入治疗配合适形放疗治疗原发性肝癌的临床观察

背景与目的：原发性肝癌最理想的治疗方法是手术切除，但近年文献报道小于5cm小肝癌切除的5年生存率稳定在50％左右，且能获手术治疗的病例仅占20％左右。肝动脉化疗栓塞术（TACE）治疗肝癌近期疗效好，被认为是非手术治疗的首选方法，但远期疗效不够理想，综合治疗是提高原发性肝癌疗效的必由之路。本研究探讨TACE配合三维适形放疗（3-DCRT）治疗原发性肝癌的疗效。方法：90例肝癌患者采用同期配对法分成两组，综合治疗组45例，采用3-DCRT＋TACE；对照组45例，单纯采用TACE。TACE方案先选择顺铂（DDP）80—120mg，羟基喜树碱（HCPT）30mg或氟尿嘧啶（5-FU）1000mg。再将多柔比星（阿霉素，ADM）或表柔比星（表阿霉素，EPI—ADM）50—100mg，或丝裂霉素（MMC）16mg，与超液化碘油10—30ml充分混合成乳剂缓缓注入，然后用1—2mm的明胶海绵栓塞供血动脉，两组均行TACE1—3次.3-DCRT采用6MVX射线，计划靶体积（PTV）〈512cm^3者单次剂量4.5—7Gy，5次／周，总DE45—56Gy；PTV≥512cm^3者单次剂量2．5—4．5Gy，5次／周，总DT 45—60Gy。结果：综合组近期疗效91．1％，对照组60％，两组差5辛有非常显著性（x^2=11．79，P〈0.01），1、2、3、5年生存率，综合组分别为88．9％，55．6％、33.3%、20.0％，对照组分别为51．1％、37．80k、20.0％、0（x^2=6．65，P〈0.01），中位生存期分别为27．3个月、16,7个月（x^2=4．75，P〈0．05）。综合组3-DCRT前PTV〈512cm^3者与PTV≥512cm^3者相比，前者3、5年生存率均大于后者（50％：20％，x：=4．5，P〈0．05；35％：8％，x^2=5.06，P〈0.05），肝功能A级和B级3年、5年生存分别为（48.3%：6．25％，x^2=8．195，P〈0．01；31％：0，x^2=4．42P〈0．05）PTV〈125cm^3者10例，其中6例生存时间超过5年，达60％。结论：TACE＋3-DCRT对不宜手术的原发性肝癌疗效好，影响预后的因素有PTV总剂量，肿瘤大小，以及肝功能分级。     

多次肝动脉化疗栓塞术对原发性肝癌的疗效及对肝功能的影响

[目的]探讨原发性肝癌行多次肝动脉化疗栓塞术（TACE）的疗效及对肝功能的影响。[方法]回顾性分析56例原发性肝癌患者行多次TACE术（≥8次）后的肝功能改变、肝硬化CT分级及疗效。[结果]多次TACE后与第一次TACE前比较,Child-Pugh分级有显著性差异（Z=-4.415,P〈0.001）,肝硬化形态显著加重（Z=-6.323,P〈0.001）。中位生存时间自第一次TACE术始为40个月。单因素分析显示患者首次TACE术前肝癌BCLC分期（χ2=15.267,P〈0.001）,肝硬化CT分级（χ2=17.176,P〈0.001）,门脉瘤栓（χ2=3.388,P=0.049）,碘油沉积类型（χ2=17.895,P〈0.001）为生存率影响因素。Cox模型多因素分析显示肝癌BCLC分期（χ2=7.646,P=0.006）,肝硬化CT分级（χ2=12.609,P〈0.001）是生存率的独立预后因素。[结论]多次TACE术治疗肝癌可获得满意的远期疗效,但会加重肝硬化。肝硬化CT分级结合Child-Pugh分级在评价TACE术后的预后和肝储备功能的变化上有重要价值。     

肝癌肝移植术后复发的诊治

目的：分析影响肝癌肝移植术后复发的危险因素，总结复发后治疗经验。方法：根据46例肝癌肝移植患者术后有无复发转移分为未复发组（33例）和复发组（13例）。结果：肝癌肝移植术后随访2年，未复发组与复发组的原发肿瘤直径分别为（8．7±2．3）cm和（9．2±2．5）cm（P〈0．05）；未复发组与复发组有门静脉癌栓等血管侵犯分别为12．1％和69．2％（P=0．001）。复发组经积极治疗后6个月、1年和2年生存率分别为100％、92％和16％。结论：肝癌肝移植术后肿瘤复发患者的总体预后差，治疗棘手，因此，重点为预防，并尽可能早期发现，积极治疗，以提高患者的生存期。     

血清前白蛋白(PA)含量在肝脏TACE术患者预后中的临床价值

目的:明确肝癌TACE术患者预后的影响因素，探讨术前前白蛋白含量在评估肝癌患者TACE术后远期预后中的价值。方法:回顾性分析上海长海医院中医肿瘤科2012年5月至2017年11月期间行肝脏TACE术的原发性肝癌患者病例资料及随访资料，用单因素分析及多因素回归分析术前多项临床参数对患者生存时间的影响。结果:共342例行肝脏TACE术的肝癌患者纳入研究。肿瘤大小、TNM分期、术前PA水平、血管侵犯是影响患者术后复发的独立危险因素。高PA组中位生存时间为29.4个月，中PA组中位生存时间16.8个月，低PA组中位生存时间为11.0个月,三组组间差异有统计学意义。结论:术前前白蛋白PA含量低是肝癌患者TACE术后总生存期的独立危险因素。     

The Use of Postoperative Serum HS-AFP and GGT Ⅱ for Judgment of the Prognosis for Hepatocellular Carcinoma patients

OBJECTIVE To investigate the clinical value of hepatoma-specific alpha-fetoprotein (HS-AFP) and gamma-glutamyltransferase Ⅱ (GGT Ⅱ) for judgment of postoperative prognosis of patients with hepatocellular carcinoma (HCC).METHODS HS-AFP was separated and determined using native polyacrylamide electrophoresis with a discontinuous buffer system and Western blots. GGT Ⅱ was separated with native polyacrylamide electrophoresis with a discontinuous buffer system and detected by enzyme staining. Forty cases with HCC underwent serial determination of HS-AFP and GGT Ⅱ before and after radical excision. The correlations were analyzed between the two indices and survival time.RESULTS In the 40 cases with HCC, before radical excision the positive rates of HS-AFP and GGT Ⅱ were 57.5% and 67.5% respectively, with the positive rate of combined HS-AFP and GGT Ⅱ reaching 80.0%. After operation, the recurrence and metastasis rate in the groups with positive HS-AFP and GGT Ⅱ were 90.9% and 58.8% respectively, while in the groups with negative HS-AFP and GGT Ⅱ the rates were 20.7% and 26.1% respectively. Recurrence and metastasis occurred in all cases with both postoperative positive HS-AFP and GGT Ⅱ but only in 9.5% of the cases in whom both postoperative HS-AFP and GGT Ⅱ were negative. Univariate analysis revealed that postoperative HS-AFP and GGT Ⅱ were related to the prognosis in HCC.CONCLUSION Postoperative serum HS-AFP and GGT Ⅱ are very useful in predicting the prognosis of HCC patients.     

The Use of Postoperative Serum HS-AFP and GGT Ⅱ for Judgment of the Prognosis for Hepatocellular Carcinoma patients

OBJECTIVE To investigate the clinical value of hepatoma-specific alpha -fetoprotein (HS-AFP) and gamma-glutamyltransferaseⅡ(GGTⅡ) for judgment of postoperative prognosis of patients with hepatocellular carcinoma (HCC). METHODS HS-AFP was separated and determined using native polyacrylamide electrophoresis with a discontinuous buffer system and Western blots. GGTⅡwas separated with native polyacrylamide electrophoresis with a discontinuous buffer system and detected by enzyme staining. Forty cases with HCC underwent serial determination of HS-AFP and GGTⅡbefore and after radical excision. The correlations were analyzed between the two indices and survival time. RESULTS In the 40 cases with HCC, before radical excision the positive rates of HS-AFP and GGTⅡwere 57.5% and 67.5% respectively, with the positive rate of combined HS-AFP and GGTⅡreaching 80.0%. After operation, the recurrence and metastasis rate in the groups with positive HS-AFP and GGTⅡwere 90.9% and 58.8% respectively, while in the groups with negative HS-AFP and GGTⅡthe rates were 20.7% and 26.1% respectively. Recurrence and metastasis occurred in all cases with both postoperative positive HS-AFP and GGTⅡbut only in 9.5% of the cases in whom both postoperative HS-AFP and GGTⅡwere negative. Univariate analysis revealed that postoperative HS-AFP and GGTⅡwere related to the prognosis in HCC. CONCLUSION Postoperative serum HS-AFP and GGTⅡare very useful in predicting the prognosis of HCC patients.     

Clinical Value of Hepatoma-Specific Alpha-Fetoprotein in the Diagnosis of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a common malignant tumor worldwide and the number 2 cause of cancer mortality in Chi- na.[1] It often develops in cases of liver cirrhosis and chronic hepati- tis. [1-3] Advanced imaging procedures including utrasonograph…     

术后复发性肝癌的介入治疗疗效分析

目的分析肝动脉化疗栓塞(TACE)治疗术后复发性肝细胞肝癌的生存率及影响因素。方法对行TACE治疗的130例术后复发性肝细胞肝癌患者进行回顾性分析,计算此类患者治疗后的生存率及生存时间,分析影响其生存的相关因素。结果全组130例总的1,3,5年生存率为83.0%、45.5%和17.6%,中位生存时间2.4年。单纯TACE治疗94例,其1,3年生存率分别为76.4%和37.1%,中位生存期2.1年;TACE联合瘤内无水酒精注射(PEI)治疗36例,1,3年生存率分别为100.0%和66.5%,中位生存期为3.5年。TACE联合PEI治疗组的生存率和生存期均显著优于单纯TACE治疗组(P<0.05),死亡风险显著低于单纯TACE治疗组(P<0.05);复发瘤直径>5cm和有远处转移者的死亡风险,显著高于肿瘤直径≤5cm和无远处转移者(P<0.05)。结论TACE联合PEI治疗,可显著提高术后复发性肝癌患者的生存率,延长生存期。     

Investigating Up-to-Seven Criteria and APRI (AST Platelet Ratio) as Prognostic Factors in Intermediate-Stage Hepatocellular Carcinoma Patients Who Received Transarterial Chemoembolization

Background: Transarterial chemoembolization (TACE) is one of the locoregional treatments for intermediate-stage hepatocellular carcinoma (HCC). Multidetector computed tomography (MDCT) is a widely used diagnostic tool for HCC. It can also evaluate tumor size, tumor number, and tumor invasion. This study aimed to determine the median survival time in intermediate-stage HCC patients who underwent TACE and to find out  prognostic factors influencing patients’ survival time after TACE. Methods: A computerized search of medical record database in Maharaj Nakorn ChiangMai Hospital from January 2016 to December 2019 revealed 187 intermediate-stage HCC patients who received TACE as the first-line treatment. Results: The median survival time of patients in this study was 9.9 months (95% CI: 8.3-11.6). The patients with aspartate aminotransferase-to-platelet ratio (APRI) less than 0.5 had a significantly better median survival time as compared with patients with APRI ratio more than 0.5; (13.2 months versus 9.9 months, p-value < 0.05). Univariate and multivariate Cox regression analysis demonstrated that tumor number > 7 and tumor size > 5 centimeters (cm) could be considered as independent parameters predicting poor overall survival time in the sufferers (HR 2.64 95%CI 1.68-4.15 and HR 2.38 95%CI 1.32-4.31, respectively). Conclusion: Based on our findings, patients with intermediate-stage HCC who received TACE had a lower median survival time compared to previous studies. However, we identified APRI less than 0.5, tumor size less than 5 cm, and tumor number less than 7 as prognostic factors improving survival time in intermediate-stage HCC patients.     

Transcatheter arterial chemoembolization and percutaneous ethanol injection for Hepatocellular carcinoma: a retrospective review of the Veterans Affairs Caribbean Healthcare System.

BACKGROUND: Hepatocellular carcinoma (HCC) is a common malignancy worldwide and has a poor prognosis. Although surgery and liver transplantation provide better outcomes, most patients are not candidates due to advanced disease, lack of donor availability, or presence of comorbidities. Several percutaneous approaches such as transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection therapy (PEIT) have been developed for local control and can potentially increase survival in these patients. METHODS: We retrospectively reviewed 33 patients with HCC who were treated with TACE, PEIT, or both from 2000 to 2005 at the VA Caribbean Healthcare System in Puerto Rico to evaluate tolerability, response, and survival. Patients were evaluated with cross-sectional computed tomography imaging to determine response using response evaluation criteria in solid tumors (RECIST). RESULTS: Thirty-three men with a mean age of 66 years were treated. Mean tumor size was 5.6 cm, ranging from 2 cm to 16 cm. All patients had cirrhosis, with alcohol abuse and hepatitis C as the most common etiologies. Objective radiographic partial response was observed in 28% of patients and 48% had disease stabilization. Most of the patients had a therapeutic response demonstrated by necrosis of the tumor and decreased contrast enhancement. Patients who underwent both TACE and PEIT had a higher response rate and disease stabilization but no difference in survival compared with those who received TACE or PEIT alone. Median survival for the whole group was 2 years. Causes of death included tumor progression, hepatic failure, gastrointestinal bleeding, and infections. The initial tumor size and Child-Pugh class did not confer a significant difference in survival rate. CONCLUSIONS: In Puerto Rico, where liver transplantation is not performed at present, percutaneous treatments are effective local therapies for patients who are not candidates for surgery and who have disease limited to the liver.     

肝动脉化疗栓塞术及射频消融术联合调强放疗治疗原发性肝癌合并门静脉癌栓的疗效及预后因素分析

目的 探讨肝动脉化疗栓塞术及射频消融术联合调强放疗治疗原发性肝癌合并门静脉癌栓的疗效,并分析相关预后因素.方法 回顾性分析63例原发性肝癌伴门静脉癌栓患者的临床资料,所有患者先行肝动脉化疗栓塞治疗1～3次,然后射频消融治疗肝内原发灶,最后采用调强放疗针对门静脉癌栓行外照射治疗.放疗结束后6～8周观察癌栓及肝内肿瘤的近期疗效,随访1、2、3年生存率观察远期疗效,对可能影响预后的因素进行分析.结果 近期疗效中门静脉癌栓完全缓解9例(15.0％),部分缓解36例(60.0％),稳定10例(16.7％),进展5例(8.3％),癌栓有效率为75.0％;肝脏原发肿瘤完全缓解19例(31.7％),部分缓解30例(50.0％),稳定6例(10.0％),进展5例(8.3％),肝内肿瘤有效率为81.6％.1、2、3年生存率分别为73.3％、45.0％、27.0％.美国东部肿瘤协作组(ECOG)评分(x2=53.046,P=0.000)、肝炎病史(x2=6.472,P=0.030)、肿瘤大小(x2=7.293,P=0.026)、肿瘤数目(x2=24.382,P=0.000)、癌栓类型(x2=28.085,P=0.000)、肝功能Child-Pugh分级(x2=6.184,P=0.040)是影响患者远期疗效的危险因素.结论 肝动脉化疗栓塞术联合射频消融术治疗肝内原发肿瘤,调强放疗治疗门静脉癌栓疗效较好,不良反应低,肿瘤反应率高;ECOG评分、肝炎病史、肿瘤大小及数目、癌栓类型、肝功能分级是影响其长期疗效的影响因素.     

肝细胞癌射频消融治疗后肿瘤残留的危险因素及预后分析

目的 探讨肝细胞癌(HCC)射频消融(RFA)治疗后肿瘤残留的危险因素及预后.方法 回顾性分析2001年5月至2007年3月114例经RFA治疗的HCC患者临床资料,分析可能与RFA后肿瘤残留有关的临床因素以及残留HCC的预后.结果 114例HCC患者经RFA治疗一次后,完全消融90例,肿瘤残留24例.90例肿瘤完全消融患者的中位生存期为40个月,24例肿瘤残留患者的中位生存期为29个月,二者差异无统计学意义(P=0.242).在24例肿瘤残留患者中,经再次治疗后达到无肿瘤残留者11例,其中位生存期为53个月;经再次治疗后仍有残留者13例,其中位生存期为28个月.RFA治疗一次后肿瘤完全消融患者与再次治疗后达到无肿瘤残留患者的中位生存期比较,差异无统计学意义(P=0.658);与再次治疗后仍有肿瘤残留患者的中位生存期比较,差异有统计学意义(P=0.012).多因素分析表明,肿瘤＞3 cm(P=0.007)和靠近大血管(P=0.042)是HCC经RFA治疗后肿瘤残留的独立危险因素.结论 肿瘤＞3 cm和靠近大血管是HCC行RFA治疗后肿瘤残留的独立危险因素.对未能达到完全消融的HCC患者,应积极采取进一步治疗措施,争取达到完全根治肿瘤,以改善预后.     

8cm以上肝癌术后残癌的肝动脉栓塞化疗预后因素分析

目的：了解肝动脉栓塞化疗对直径大于8cm肝癌术后残癌的疗效和影响预后的因素。方法：肝癌切除术后2个月内经超声和动脉造影证实有残癌的肝癌患者，行肝动脉栓塞化疗；采用COX模型研究影响疗效的因素。结果：治疗后1，2，3，4年生存率为74.9%，44.2%，36.8%，18.4%。肝癌切除术后残癌的TNM分期是影响疗效的独立因素（P=0.003)。而原发癌的肿瘤分期，手术方式（局部切除或肝叶切除），肝动脉栓塞化疗的次数，不是影响预后的独立因素。结论：肝癌术后行肝动脉栓塞化疗是可行的，术后残癌的分期是影响肝动脉栓塞化疗效果的主要因素，大体积肿瘤术后尽早行肝动脉栓塞化疗是必要的。